Tuesday, July 18, 2017

The Senate Republicans' effort to overhaul the nation's health-care system collapsed on July 17 and 18, when multiple Republican senators came out against both the revamped bill and President Trump's suggestion of repealing Obamacare and letting the markets "fail" before replacing it. (Video: Jenny Starrs/Photo: Melina Mara/The Washington Post)

As divisions between the two main ideological camps within the GOP widened Tuesday, Republicans were scrambling to contain the political fallout from the collapse of a months-long effort to rewrite former President Barack Obama’s signature domestic accomplishment.

President Trump predicted Tuesday that Republicans would wait for the federal insurance market to collapse and then work to broker a deal to rewrite the nation’s landmark health-care law, while Senate leaders pressed ahead with a plan to repeal the Affordable Care Act with no immediate replacement.
But it became quickly apparent that GOP leaders, who were caught off guard by defections of their members Monday night, lacked the votes to abolish parts of the 2010 law outright. Three centrist Republican senators — Susan Collins (Maine), Shelley Moore Capito (W.Va.) and Lisa Murkowski (Alaska) — all said they would oppose any vote to proceed with an immediate repeal of the law.
“I did not come to Washington to hurt people,” Capito said on Twitter. She added, “I will only vote to proceed to repeal legislation if I am confident there is a replacement plan that addresses my concerns.”

The Senate's healthcare overhaul appears to be in trouble after two more Republicans say they oppose a revised version of the bill. (Reuters)

Collins said in a statement that she had urged Senate Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tenn.) to hold hearings in an attempt to fashion a new legislative fix for the ACA, while leaving it in place in the meantime.

“We can’t just hope that we will pass a replacement within the next two years,” she said. “Repealing without a replacement would create great uncertainty for individuals who rely on the ACA and cause further turmoil in the insurance markets.”

A handful of other senators, along with 11 GOP and Democratic governors, also called on congressional leaders to launch a bipartisan process to revamp the nation’s health care system.

Sen. Ron Johnson (R-Wis.) said Tuesday that lawmakers need to get a more detailed analysis of what has caused consumers’ premiums to rise and what could make insurance more affordable.

“We didn’t have the courage to lay out exactly what caused premiums to increase,” Johnson said, noting that senators didn’t even have an up-to-date budget analysis of the latest health -are proposal. “It’s an insane process. If you don’t have information how can you even have a legitimate discussion and debate.”

The 11 governors--a group that included Republicans Charles D. Baker (Mass.), Larry Hogan (Md.), John Kasich (Ohio), Brian Sandoval (Nev.) and Phil Scott (Vt.) — said they “stand ready to work with lawmakers in an open, bipartisan way to provide better insurance for all Americans.”

But these appeals did little to sway Trump, who blamed the demise of a plan to rewrite the ACA in a tweet on Democrats “and a few Republicans.”

Speaking to reporters in the Roosevelt Room on Tuesday afternoon, Trump said he was “disappointed” in the demise of the Senate bill and viewed the cratering of the nation’s individual insurance market as the best way to advance his goals.

Now his plan is to “let Obamacare fail; it will be a lot easier,” he said. “And I think we’re probably in that position where we’ll just let Obamacare fail.”

“We’re not going to own it. I’m not going to own it,” the president said. “I can tell you the Republicans are not going to own it. We’ll let Obamacare fail, and then the Democrats are going to come to us.”

Trump’s latest comments intensified the current political uncertainty on Capitol Hill, where GOP leaders were debating what to do next, and they raised anxiety among insurers that must commit to staying on the federal health exchange within a matter of weeks.

Republicans are reeling after two more GOP senators declared their opposition Monday to the party’s plan to overhaul the nation’s health-care system, likely ending their quest to make good on a GOP promise that has defined the party for nearly a decade and has been one of Trump’s top priorities.

In many ways, the leadership plan did not go far enough for those on the right, but was too radical for GOP centrists. It scaled back some key ACA requirements and made deep cuts over time in Medicaid, but preserved popular provisions of the law such as a ban on denying coverage to consumers with costly medical conditions.

Sen. Orrin Hatch (R-Utah) said he was “very concerned” by the overall situation and he offered a blunt assessment of why Senate Republicans fell short on their bill.

“We are so evenly divided and we’ve got to have every Republican to make things work and we didn’t have every Republican,” he said.

After a weekly Senate GOP policy lunch that went longer than usual, Senate Majority Leader Mitch McConnell (R-Ky.) told reporters there would be a vote on repealing the ACA, with a two-year delay, “some time in the near future.”

He said the health-care push has been “a very, very challenging experience for all of us.” Asked whether he would eventually be open to working with Democrats on something, McConnell said “we’ll have to see what happens” with the repeal-first effort.

McConnell said he expected committee hearings down the road on the “crisis ahead” on health care. And he sought to defend his accomplishments during the first six months of the year. But beyond confirming a Supreme Court justice, McConnell has no other major achievements.

“Last time I looked, Congress goes on for two years,” he said.

But in a sign of the extent to which Senate leaders have lost control of the process, Senate Majority Whip John Cornyn (R-Tex.)--whose job is to count votes--said he had “no idea” that Sen. Mike Lee (R-Utah) was suddenly going to join Sen. Jerry Moran (R-Kan.) in defecting Monday night.
Cornyn learned about it that night “a little after 8 o’clock,” he said, after he and six other GOP senators dined with Trump at the White House.

As Republicans tried to regroup, Senate Minority Leader Charles E. Schumer (D-N.Y.) renewed his calls for the majority to work with Democrats to shore up the health insurance system.

“It should be crystal clear to everyone on the other side of the aisle that the core of the bill is unworkable. It’s time to move on. It’s time to start over,” he said. “Rather than repeating this same, failed partisan process again, Republicans should work with Democrats on a bill that lowers premiums, provides long-term stability to the insurance markets and improves our health-care system.”

“Now that their one-party effort has largely failed, we hope they will change their tune,” he said, noting that some Republicans have been calling for bipartisan talks.

Schumer quoted Sen. John McCain (R-Ariz.), who said Monday night that “Congress must return to regular order” and rewrite the health-care legislation with input from both parties.

“The door to bipartisanship is open now. Republicans only need to walk through it,” Schumer said.
As Schumer spoke on the Senate floor, Sen. Joe Manchin III (D-W.Va.), one of the few in the chamber who has tried to be a bipartisan broker, was placing calls to fellow senators who, like him, are former governors — a total of 11 senators including Alexander, John Hoeven (R-N.D.), Mike Rounds (R-S.D.), Angus King (I-Maine), Jeanne Shaheen (D-N.H.) and Maggie Hassan (D-N.H.). Aides said Manchin was presenting nothing specific yet to his colleagues, just a plea to “sit down and start bipartisan talking.”

But Vice President Pence, speaking at the National Retail Federation’s annual Retail Advocates Summit, challenged Congress to “step up” and repeal the current law “so that lawmakers can “work on a new health-care plan that will start with a clean slate.”

And McConnell declared on the Senate floor, “This doesn’t have to be the end of the story.”

The confusion over next steps highlights the predicament now faced by Republicans, who have made rallying cries against Obama’s 2010 health-care law a pillar of the party’s identity. They may be forced to grapple with the law’s shift from a perennial GOP target to an accepted, even popular, provider of services and funding in many states, which could make further repeal revivals difficult.
Meanwhile, Trump and other Republicans will confront a Republican base that, despite fervent support for the president, still seeks a smaller federal government and fewer regulations.

But the fact that it would reduce federal Medicaid funding and phase out the program’s expansion in 31 states and the District of Columbia rankled several key GOP governors and senators, who feared that their states would be saddled with the unpalatable choice of either cutting off constituents’ health coverage or facing a massive new financial burden.

The opposing pressures have left McConnell in a tough position as he has struggled to find a solution, which is why he has now thrown out the idea of moving to an immediate repeal.

Abolishing several of Obamacare’s central pillars — including the mandate that taxpayers buy coverage, federal subsidies for many consumers’ premiums and Medicaid coverage for roughly 11 million Americans — could wreak havoc in the insurance market. A Congressional Budget Office analysis in January estimated that premiums in the individual insurance market would rise between 20 and 25 percent next year and would roughly double by 2026.

At the same time, according to the CBO, the number of uninsured would spike by 18 million next year and rise to 32 million by 2026.

“For insurers, the worst possible outcome in this debate has always been a partial repeal with no replacement, which is exactly what Congress is about to take up,” said Larry Levitt, senior vice president for special initiatives at the Kaiser Family Foundation, in an email. “Insurance companies would be on the hook for covering people with preexisting conditions, but with no individual mandate or premium subsidies to get healthy people to sign up as well.”

While pursuing an immediate repeal would please conservatives, the fact that it lacks sufficient support leaves McConnell and House Speaker Paul D. Ryan (R-Wis.) with few good options.

Another move, which McConnell threatened recently, would be to work with Democrats to prop up the insurance exchange markets that have been imploding in some states — which probably would win passage but would infuriate the conservative base that has been calling for the end of the Affordable Care Act.

But Ryan showed little interest Tuesday in making common cause with Democrats, telling reporters that House leaders “would like to see the Senate move on something” to keep the repeal-and-replace process alive.

In a closed-door conference meeting, according to several members present, Ryan told colleagues that the ball remains in the Senate’s court and announced no plans for further action on health care in the House. He also urged House members to be patient and not to openly vent frustration with the Senate, the members said.

Publicly, he emphasized that the Senate had “a razor-thin majority” and that passing legislation is “a hard process.”

Speaking to reporters Tuesday, Sen. Marco Rubio (R-Fla.) said senators’ willingness to deny Trump one of his top priorities has less to do with the president’s political standing and more with home state pressures, “whether it’s their governors, or the way health care is structured in their individual states.”
“This is the Senate. Leadership sets the agenda, but senators vote in the interests of their states,”